Prior Authorization Pharmacy Technician
Job Summary
The Prior Authorization Pharmacy Technician will process and manage pharmacy prior authorization requests to ensure high-quality decision-making. This role involves collecting medical information, coordinating with pharmacists and physicians, and maintaining compliance with regulatory standards. You will work remotely while providing essential support to improve the overall member and provider experience.
Responsibilities
- Process and track prior authorization requests
- Coordinate documentation between medical staff
- Ensure compliance with PA criteria and regulations
- Maintain timely communication of authorization outcomes
Required Skills
- Pharmacy Technician Certification (CPhT)
- 2+ years pharmacy or PA experience
- Strong customer service and phone etiquette
- Proficiency in clinical documentation
Job Details
Responsibilities:
- Use Oscar and vendor tools to determine eligibility, screen for required documents, create, process, and properly track pharmacy prior authorization requests.
- Prepare, organize, and distribute pharmacy prior authorization requests for review by pharmacist/physician and respond to pharmacist/physician requests for additional information.
- Collect relevant medical information (via telephone, fax, and portal) and apply the appropriate PA criteria, clearly documenting all communication and decision making.
- Meet required decision-making timeframes, including promptly triggering escalation for cases requiring pharmacist review.
- Communicate oral and written prior authorization outcome notifications that comply with standards and requirements for content and accuracy.
- Compliance with all applicable laws and regulations.
- Other duties as assigned.
Requirements:
- 2+ years of work experience in a pharmacy related field in a retail or managed care plan setting and/or prior authorization experience.
- Active, unrestricted Pharmacy Technician certification (CPhT).
- Excellent customer service, phone etiquette, and typing skills.
Bonus Points:
- 1+ years of performing pharmacy reviews for a managed care plan or pharmacy benefits manager.
- Experience working with CVS Caremark's portal and criteria.
- In-depth understanding of how to operationalize step therapy rules and regulations.
- Strong verbal and written communications, and interpersonal interactions.